Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE
NUEVA VIZCAYA PROVINCIAL POLICE OFFICE
BAYOMBONG POLICE STATION
NUEVA VIZCAYA

BPSIN-54 April 05,2013

POLICE CLEARANCE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that as per duly verified available records in this office/
station,subject person whose name, picture and other personal circumstances appear here
under has pending case filed against HIM as of this date.

FIRST NAME JEFFREY

SURE NAME GULGULWAY
MIDDLE NAME BATA
QUALIFIER N/A
AGE 31 YEARS OLD
ADDRESS NO. 4 BAY. NUEVA VIZCAYA
DATE OF BIRTH JULY 29 1982
PLACE OF BIRTH PLACE OF BIRTH
GENDER MALE
CIVIL STATUS SINGLE
PROFESSION/ SALES AGENT
OCCUPATION
NATIONALITY FILIPINO
PURPOSE FOR FIREARM LICENSE
REMARKS NO CRIMINAL/ DEROGATORY RECORD

________________________ THUMBMARKS
Signature of applicant LEFT RIGHT

CTC NO :06992101
ISSUED AT : Bay. Nueva Vizcaya
ISSUED ON : 04-05-13
O.R NO. : 8723512

Processed/Verified by: Noted by:

ALVIN C. FRANCISCO ROBEN V. GRAGASIN

Police Officer III Police Senior Inspector
Duty PNCO Chief of Police

This certificate is valid only for 6 months from date of issuance.

NOTE: Not valid if there are erasures.